Our Ability Jobs

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Receive, review and process Outpatient Treatment Requests (OTR) from providers as it relates to eligibility, benefits and authorization of services. Resolve issues and educate providers on policies and procedures.

• Review OTR for accuracy and completeness of data and interact with providers

• Perform research for OTR discrepancies as identified by providers

• Create member authorizations for approved outpatient therapy services

• Verify member eligibility and provider contracting/credentialing status prior to authorizing services

• Coordinate outpatient treatment requests with Care Coordination staff for out-of-network providers

• Coordinate with eligibility staff for member eligibility discrepancies and update system as necessary

• Coordinate outpatient treatment requests with Medical Management team for medical necessity

• Modify authorizations as needed to ensure transfer into claims payment system

• Identify and refer provider status discrepancies to Provider Relations for follow-up

• Ensure established processing timeframes are met for each business unit

• Create and maintain reference materials and workflows for data processing

• Provide back-up to customer service for increased call volume

• Track and maintain monthly reporting log

Education/Experience: High school diploma or equivalent. 2+ years of customer service and/or data entry experience. Knowledge of medical/behavioral terms and codes preferred.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

TITLE: Behavioral Referral Specialist

LOCATION: Various, Missouri

REQNUMBER: 1409013